Urothelial Carcinoma of the Bladder With Primary Metastasis to the Brain: A Case Report and Literature Review

Abstract

Brain metastases are the most common type of brain tumor in adults, commonly arising from primary tumor sites of the lung, breast, skin (melanoma), colon, and kidney. Isolated central nervous system (CNS) metastasis arising from urothelial carcinoma (UC) is a rare presentation yielding a poor prognosis.A 71-year-old male patient with a history of urothelial carcinoma, treated one year prior with partial cystectomy and adjuvant gemcitabine and cisplatin (GC) therapy, presented with worsening neurological symptoms, including progressively worsening dizziness, shuffling gait, drifting, expressive aphasia, and confusion. MRI revealed a left frontal 4.0 x 3.6 cm brightly contrast-enhancing tumor with possible hemorrhage, extensive vasogenic edema, and moderate mass effect. An additional smaller right cerebellar lesion was also noted. Outpatient CT of his chest, abdomen, and pelvis revealed no evidence of other malignant sites. He ultimately underwent a left craniotomy with a total resection of his left frontal mass. Pathological examination revealed a urothelial primary. Post-operative MRI revealed complete resection of the left frontal mass and the patient was discharged with no neurologic deficits on exam.In many cases, brain metastases may present years later following initial therapy of UC as the CNS may act as a sanctuary site during systemic chemotherapy. Chemotherapeutics such as gemcitabine with better penetration of the blood-brain barrier may be beneficial in delaying the onset of these metastases.

Metastatic Urothelial Cell Carcinoma Presenting as an Isolated Malignancy to the Posterior Fossa: A Case Report and Review on the Literature

“…Although these chemotherapeutic agents have been quite successful in treating local UCC and visceral organ spread, they have poor penetrance through the blood-brain barrier. It is proposed that there may be a subpopulation of cancer cells that are able to seed the CNS, survive the chemotherapy effects, and later present with CNS metastasis in the absence of other distal metastasis [ 2 , 18 ].…”

“…Bladder cancer is the sixth most prevalent malignancy in the United States [ 1 ]. Urothelial cell carcinoma (UCC) makes up 90% of all types of bladder cancer [ 1 , 2 ]. The literature estimates that distal metastasis occurs in 10%-29% of patients with bladder UCC.…”

“…The literature estimates that distal metastasis occurs in 10%-29% of patients with bladder UCC. The most common sites of distal metastasis, in order of most to least prevalent, are the lymph nodes, liver, peritoneum, lungs, and bones [ 2 , 3 ]. Metastasis to the central nervous system (CNS) can occur but is extremely rare [ 1 ].…”